| NPI | 1831593383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELUS GALLO PANCHO Manager 904-800-2653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL AL12549) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2014-10-13 |